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American College of Surgeons Hosts Capitol Hill Briefing on Combat Casualty Care

Panelists discuss successes and challenges of military surgical care and how an integrated military-civilian trauma system can help save lives.

WASHINGTON, DC (July 23, 2018): The American College of Surgeons (ACS) hosted a Capitol Hill briefing earlier today featuring a panel of experts on military surgical care. Rep. Michael Burgess, MD (R-TX) was also a Congressional guest. Speakers focused on themes from the recent publication, Out of the Crucible: How the U.S. Military Transformed Combat Casualty Care in Iraq and Afghanistan.1

“Battle-tested trauma care is an invaluable resource in an active combat zone, and our military trauma surgeons are the best in the business. Unfortunately, the need for expert trauma care extends far beyond the battlefield. By building military-civilian partnerships between military trauma experts and civilian physicians, innovation perfected on the battlefield is saving lives here at home,” said Rep. Burgess. “Through legislation, such as the bipartisan Mission Zero Act, Congress is helping to foster collaboration between our Armed Forces and civilian doctors as we seek to provide the best possible care for our military and American patients. As we consider life-saving solutions, I am grateful for the opportunity to work on this important issue alongside dedicated partners, including the American College of Surgeons.”

Attendees learned that the prolonged conflicts during Operation Iraqi Freedom and Operation Enduring Freedom saw an unprecedented improvement in military combat casualty care and the creation of the Joint Trauma System (JTS), allowing for the development and dissemination of best trauma practices across the Department of Defense. Preserving the JTS and establishing a fully integrated military-civilian trauma system are among the primary efforts of the Military Health System Strategic Partnership American College of Surgeons (MHSSPACS), launched in 2014 to facilitate collaboration and the exchange of information between ACS and the U.S. Department of Defense Military Health System.

The American College of Surgeons held a Capitol Hill briefing today with  panel of experts on military surgical care that featured an important discussion on the successes and challenges of combat casualty care and strategies for the future.  Pictured: John H. Armstrong, MD, FACS; Arthur Kellerman, MD, MPH; Rep. Michael Burgess, MD (R-TX); Captain Eric Elster, MD, FACS, USN; and. Colonel Frederick Lough, MD, FACS, USA.   Photo: American College of Surgeons

“The reciprocal exchange of ideas and innovation between military and civilian medicine over the past decade and a half of conflict has been unprecedented and has saved numerous lives both overseas and at home,” said panelist Captain Eric A. Elster, MD, FACS, USN, professor and chair, USU-Walter Reed department of surgery, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences. “Such relationships are reinforced and sustained by activities like the military’s partnership with the American College of Surgeons.”

In recent years, injury severity on the battlefield has increased, but mortality is decreasing.2 However, military surgeons continue to face a number of challenges, such as the combination of long deployments and low surgical case volume, and the retention of knowledge, skills, and abilities during peacetime. Due to the occurrence of mass casualty events, natural disasters, and intentional human violence, civilian trauma centers often see injuries similar to those encountered on the battlefield. An integrated trauma system where military surgeons can train during peacetime, and where lessons can be brought back from the battlefield, will help prepare and preserve the skills of military surgeons and enhance civilian trauma care.

“Expanding collaboration between civilian and military trauma systems will save more lives at home and in the combat zone,” said panelist John H. Armstrong, MD, FACS, associate professor of surgery, Morsani College of Medicine, University of South Florida Health, and adjunct professor of surgery, Uniformed Services University of the Health Sciences. “By learning from each other, civilian and military trauma teams can elevate care and save more lives from severe injury.”

Using a tourniquet to stop bleeding is a specific example of a technique from the battlefield that is now saving civilian lives. More than 335,000 people have learned bleeding control techniques through the national Stop the Bleed® campaign (approximately 315,000 in the U.S. and 20,000 in other countries). Members of the public now have the ability to become an active/immediate responder to help save a life when someone is severely bleeding and emergency medical help is not immediately available.

“The use of tourniquets to stop bleeding, and maintaining body temperature, spine protection, and rapid transport of the injured patient to the next level of care, are critical to saving lives on the battlefield. These measures are now being implemented in the civilian setting and are benefiting patients across the United States,” said panelist Colonel Frederick Lough, MD, FACS, USA, chief, department of surgery, Walter Reed National Military Medical Center, and deputy chair, department of surgery, Uniformed Services University of the Health Sciences. “The true heroes of the wars in Iraq and Afghanistan are the Combat Medics who use the above noted measures and risked their lives to save others.”

The efforts of MHSSPACS and the push for a fully integrated trauma system are in line with the recommendations of the 2016 National Academies of Sciences, Engineering, and Medicine (NASEM) report, A National Trauma System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths after Injury. Achieving zero preventable injury deaths is also a priority of the ACS Committee on Trauma, which has worked to bring together multidisciplinary professionals and organizations to build a National Trauma Action Plan.

The NASEM report also provided the impetus for the Mission Zero Act (H.R. 880/S. 1022), currently working its way through Congress. The ACS-supported legislation, sponsored by Rep. Burgess, establishes grant funding for military-civilian trauma partnerships and would create a pathway to provide patients with the highest quality of trauma care in times of both peace and conflict.

The recent Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAI) (H.R. 6378/S. 2852) legislation, which would reauthorize the Pandemic and All Hazards Preparedness Act (PAHPA) established in 2006 to improve the nation’s response to public health and medical emergencies, is up for its second funding reauthorization and includes the Mission Zero Act. The ACS is actively supporting passage of PAHPAI, particularly the inclusion of the trauma-related provisions and the Mission Zero Act language included in the legislation.

"FACS" designates that a surgeon is a Fellow of the American College of Surgeons.


1 Kellerman A L, Elster E. Out of the Crucible. Fort Sam Houston, TX: Borden Institute, 2017.

2 Rasmussen TE, Gross KR, Baer DG. Where do we go from here? Preface. US Military Health System Research Symposium, August 2013. J Trauma Acute Care Surg2013 Aug;75(2 Suppl 2):S105-6.

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The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 80,000 members and is the largest organization of surgeons in the world. For more information, visit